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Welcome to the team! We hope you enjoy your experience on AMU and feel a valued member of the team while you are with us. For students on placement, consider what you would like to achieve whilst with us and how we could help you to do this!

We hope you find all the information you need to gain an insight to how the unit works and the variety of MDT members involved in patient care.

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The Values and Behaviours Framework for ABHUB identifies 4 key objectives for anyone working within the trust.

These are:

Patient first

Personal responsibility

Passion for improvement

Pride in what we do

Please ensure that you familiarise yourself with this framework (see link above) as it underpins what our expectations are and how you can strive to achieve them.

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Please ensure you read and understand the ABUHB Managing Attendance at Work and the All Wales Dress Code Policy, to maintain a professional outlook.

If you are unable to attend for any reason, you need to contact the Nurse In Charge by calling main reception on 01633238030, or calling 01633 238899 to access vocera.

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All Wales NHS Dress Code

Free to Lead, Free to Care

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Melissa Rees - Senior Nurse

Kirstie Dobson - AMU Sister

Deputy Sisters:

Amanda Coles

Sian Coles

Maria Cruz

Emma Lloyd

ANPs

Rachel Jones

Rosie Downes

Sophie Taylor

Gwen Ortega

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Acute Care Physicians (ACP-Consultants) based within AMU

Review patients for admission/discharge AM post take ward round (PTWR)

Dr Haris Saleem (Wednesday - Friday)

Covering Acute Medicine ward rounds (rotating basis)

Dr Hannah Brothers

Dr Ferran Cavalle

Dr Tom Cozens

Dr Llifon Edwards

Dr Vinod Mathrani

Dr Paul Mizen

Dr Wendy Munro

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AMU provides care for adults (17 years and over) who are referred for NHS treatment for a suspected or confirmed acute medical issue, meeting the local general hospital criteria. They are referred from Primary Care, Outpatient departments or the Minor Injuries Unit. They will either self-present, be transferred with a staff member or be brought in by ambulance.

On arrival, patients will have observations performed and a brief assessment of the patient's condition is carried out and documented by the triage nurse. Bloods will be taken according to the presenting condition, an ECG performed if necessary, and cannulation if deemed appropriate. A point of contact respiratory swab may also be taken for those presenting with respiratory symptoms.

Taking into account the NEWS, ECG report (if required) and clinical presentation of the patient, a decision will be made to how urgently the patient needs to be reviewed by the medical team. Any acutely unwell patients must be escalated immediately to the NIC and medical team, and transferred to an appropriate area asap. Consider if the 'Sepsis Six' would be required and use this tool to escalate your patient.

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Triage/AMU waiting area

For patients who meet the 'fit to sit' criteria to wait for assessment in a chair.

There is also:

x2 triage assessment trolley spaces

x4 medic assessment couches

x3 cubicles available to use for patients who need isolating whilst waiting for assessment.

Also recliner/arm chairs for patients needing treatments/longer stays in the waiting area, but unable to transfer to the trolley area due to capacity issues.

AMU trolleys

For those patients unsuitable to remain in the waiting area for assessment; requiring urgent treatment; or needing admission to hospital. Comprising of x3 cubicles, x4 bed spaces and x7 trolley spaces.

Ward D1 West

x2 6 bedded bays to accommodate Acute Med patients and/or 'defined' patients awaiting transfer to the appropriate wards. Additional 6 bedded bay utilised to accommodate periods of high demand.

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The patient will be seen by a medical doctor or ANP for initial clerking, where they complete the Emergency Clerking proforma, detailing patients' medical history and the ongoing medical plan. These patients are identified in GREEN on the patient information board. The patient will then be reviewed again by a Consultant (this sometimes happens the following morning) on the Post Take Ward Round (PTWR). They will determine if the patient is safe for discharge or whether they need further treatment and assessment. If the patient is to remain in hospital, they will be 'defined' to the appropriate team for their needs.

The teams are:

Acute Med (red) - for patients requiring a stay of up to 72 hours.

Gen Med (black) - patients who need a longer treatment time, or discharge planning but are <65 years.

EFU (blue) - patients over 65 years, frail with expected stay of up to 7 days.

COTE (black) - patients over 65 years, needing a more prolonged stay/complex discharge planning.

ENDOCRINE (black) - those requiring input from the endocrine team.

STEP UP

This process is followed when a deteriorating patient needs more acute care than can be provided in RGH, and therefore requires transfer to GUH. A medic will arrange this via the flow centre. Patients may also be transferred if they need certain specialist input such as Cardiology, Gastroenterology, Respiratory or Stroke.

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For patients who need to stay in hospital, risk assessments need to be completed on Welsh Nursing Care Record (WNCR) and a Multifactorial Falls Risk Assessment (MFRA) for those at risk of falls, ideally within 6 hours of admission. It is important to record height, weight and lying and standing BP, to ensure a thorough assessment has been made.

Appropriate monitoring forms should also be implemented (e.g. fluid balance, cannula bundle) according to ABUHB policy.

All nursing, medical and MDT entries are documented on the medical continuation sheet, using real time documentation, to provide a clear continuation of care. Please ensure that all entries are dated, timed and signed at the point of completion, and that your name is clearly printed at the beginning of every shift in order to allow for accountability. Always encourage colleagues to do the same!

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When a patient is identified as medically fit for discharge, there are certain processes that need to be considered to ensure this is done safely.

An e-discharge will need to be completed by the medical team, providing information to the patient's GP regarding the treatment/investigations performed and any updates to their medication. If any new medication is needed, a WP10 (green prescription) will be provided, to be collected from the community pharmacy.

If a patient is unable to get to a community pharmacy, has a dosette box, is from a residential/nursing home, or are under the care of the frailty team, then a TTH (to take home) may be required. Please prompt medics to complete as soon as possible in order for pharmacy to dispense accordingly.

CAATT are now based on the unit Monday-Friday 9-5, to assist with any therapy needs the patient may have and Rachael is our discharge coordinator available Monday to Friday 8-4, who will be able to assist liaising with the Social Work teams to restart or request care packages.

Please ensure that cannulas are removed before discharge, NOK are informed as necessary and that the patient has means to access the property. Those returning to residential/nursing homes need a transfer document completed to send with them and a verbal handover made.

Please consider whether a referral to the community teams (e.g. for insulin administration, wound care, catheter care) is required. If so, this is to be made via the Single Point of Access line 03003033557 and appropriate documentation (e.g. catheter passport, supplementary drug chart) sent with the patient.

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Please check if patients have brought in their own medications and place in the secure lockers above the patient's bedside. Any controlled drugs (CDs) should be sent home or placed securely into the ward Omnicell (medication cabinet) and entered into the patient's own CD book.

AMU has two treatment rooms with an Omnicell to dispense medication, which is fingerprint operated by each qualified member of staff. You will find a large range of medications here, however not all may be stocked. If a medication is unavailable, this must be sought from the patient/family, requested from pharmacy or from another ward if possible. It is not acceptable for medication to be persistently unavailable or '5' to be written on the drug chart. The unit has pharmacy cover 9-1pm weekdays and a communication book is kept in the pharmacy office, where you can request supply of medications that are unavailable. At weekends, pharmacy requests need to be taken directly to them to dispense.

If a patient has a dosette box, these medications are not to be used. Patients who wish to use their own individually boxed medication must be observed when doing so, to ensure that it corresponds to the prescription chart. 'Self' is not to be written on the drug chart. Please highlight any discrepancies to the medical/pharmacy teams.

All controlled drugs (CD's) must be countersigned by two qualified staff (or RN and 3rd year student) checking that the amount in the Omnicell tallies with the amount documented in the CD book.

Please be vigilant that you are using the appropriate resources available (BNF, Medusa) if unsure about any medication or how to administer it.

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We generally work 12.5 hour shifts 0700-1940 or 1900-0740, but can accommodate 'half' shifts if needed.

Ambulatory shifts are 0800-18.30 RN, 1000-1800 HCSW.

Car parking facilities are available on level 4 Friars entrance, overflow car park opposite the hospital (Mendalgief) or Park Square public car park (free parking on presentation of ID badge).

You are entitled to two breaks of 20 minutes, one in the morning and one in the afternoon. These start at 0915-0930, then 1330, and are staggered over three sessions to ensure adequate staffing on the unit. If you are unable to take your break at the time allocated to you, please inform the NIC or see if a colleague can swap with you.

Our staff room has a fridge, microwave and kettle. Please keep this area clean and tidy and shut the door after leaving.

The Restaurant is on level 3 serving hot food 8-8 and Costa next door to us on level 1.

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Sister's Office 01633 238652

Reception 01633 238030

AMU main unit 01633 238117/236338

Triage 01633 238995

Nurse in Charge (via vocera) 01633 238899 'Name/MAU Nurse in Charge'

Kirstie.Dobson@wales.nhs.uk

Amanda.Coles@wales.nhs.uk

Sian.Coles@wales.nhs.uk

Maria.Cruz@wales.nhs.uk

Emma.Lloyd67@wales.nhs.uk

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AMU may feel daunting when you first arrive, we all remember our first impressions of the unit! Stay positive as with time and exposure, your understanding of the unit and its processes will grow.

AMU will provide you with fantastic opportunities to learn new skills and further develop existing ones. It is an exciting and fast paced environment which is very rewarding to be a part of.

We hope that you make the most of every opportunity made available to you and we aim to guide you to do this to the best of our ability.

You always have the support of the management team and other colleagues, please seek this at any time! The office door is always open to for any advice or help you need.

We look forward to working with you!

Team AMU